Name*

Email*

Phone*

Date of Birth*

Country Preference(Multiple Choice)*

Select CountryGeorgiaMalaysiaPolandUKHungaryKyrgyzstanBarbadosLatviaRussiaArmeniaLithuaniaKazakhstanRomaniaPhilippinesBangladesh

List 5 Countries Preference in order separated by commas(,)

Course Preference(Multiple Choice)*

Select FieldAccounting & FinanceArts & ScienceEngineeringManagementMedicineMBBSNursingPara MedicalShort Time CoursesTourism & Hospitality

List 5 Courses Preference in order separated by commas(,)

Intake*

10th - Year of Passout

Percentage % of Score

Board/University

12th - Year of Passout

Percentage % of Score

Board/University

Degree - Year of Passout

Percentage % of Score

University

Masters - Year of Passout (If any)

Percentage % of Score

University

No of Backlogs

IELTS/PTE/TOEFL (Demo: Name first, overall:, speaking:, reading:, listening:, writing:)

Gap between educations (if any)

Father Name*

Occupation*

Contact*

Mother Name*

Occupation*

Contact*

Counselor Attended*

Date of Application*

Branch of Application*

Feedback(If any)

Referrence If

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